Clinical Indications for Pharmacists and Medicines Optimisation Teams

What does the indication add for a pharmacist?

The reason for the medicine. Pharmacists record the indication with the directions (FAQ 4), and FAQ 7 calls it “particularly helpful to dispensing pharmacists” in balancing a medicine’s risk and benefit for a given patient. See community pharmacy for labels and medicines use reviews.

FAQ 2 says prescriptions with clinical indications are “very popular with patients, carers, primary care staff and pharmacists”. In a 2019 UK hospital study, pharmacists called indications “helpful” or “useful” (hospitals).

How can indications support medication reviews?

They show what each medicine is for. FAQ 7 says lists of indications linked to repeat prescriptions give “a rudimentary active patient summary list”. Dr Masters’ 2013 BMJ letter proposed adding the indication at the time of issue to avoid problems of polypharmacy.

A 2016 NEJM commentary by Schiff and colleagues advocates indications-based prescribing, coupled with health information technology, as a way to improve team communication, medication reconciliation, and patient education and compliance (PubMed).

How could a team roll it out across practices?

The site’s material covers four things:

• Patients first: over 75s, then over 65s, then groups such as patients with diabetes or heart disease, or anyone on more than four items (FAQ 9).
• Shared wording: FAQ 7 says indications “should be standardised as much as possible”, with prescribers picking recommended phrases from lists. The Sample Directory is a start: practices and medicines teams may reuse it, for example in their own formulary, as long as they credit Dr Masters. It is an example, not a working directory, so check each phrase; FAQ 8 says it “will require refinement and adaptation over time”.
• Coverage audits: a departure audit of repeat scripts against an 80% standard, and a destination audit at care homes (audits, care homes).
• Training: FAQ 11 says widespread use will need an education programme, and that all prescribers will need training.

In 2005 and 2006, Wycombe Primary Care Trust hosted clinical indications, including the directory, in the medicines management part of its website.

Should indication fields be mandatory?

The hospital studies give different answers. A 2019 UK study found that only 4 of 64 trusts required an indication for all medicines, and its authors warn that mandatory fields “may be counterproductive”. A 2025 study in Christchurch, New Zealand, found that a compulsory field raised recording from 29% to 76%, with no change in medicine use.

Do indications improve adherence?

That has not been shown in the work on this site. FAQ 6 says “at present there is no evidence that clinical indications assist with adherence”, and Dr Masters’ single-practice statin study calls for “prospective studies with controls”. The 2026 systematic review adds that only one of its 24 studies examined prescriptions for all medicines. See research.